Social Determinants of Health and Older Adults

Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

Healthy People 2030 groups SDOH into 5 domains:

• Economic stability
• Social and community context
• Education access and quality
• Health care access and quality
• Neighborhood and built environment

SDOH have a major impact on our health, well-being, and quality of life — and SDOH significantly affect our chances of staying healthy as we age. For example:

• Older adults with lower incomes are more likely to have disabilities and die younger. 1 In addition, disability is likely to start earlier in life for people with lower incomes — further raising the risk of early mortality. 2
• Social isolation and loneliness are associated with a higher risk of dementia and other serious health problems in older adults — while having positive social relationships can help people live longer, healthier lives. 3
• About 8 in 10 older adults struggle to use medical documents like forms or charts, 4 which could make it harder for them to make well-informed health decisions.
• Most older adults in the United States have at least 1 chronic health condition, 5 making access to affordable, quality health care a priority. However, factors like a lack of health care options in rural areas, high out-of-pocket costs, and transitions from private insurance to Medicare often complicate older adults’ care.
• As mobility decreases with age, 5 accessible neighborhoods and a built environment with convenient access to grocery stores and safe places to get active become increasingly important.

Older adults’ health and well-being also has broader implications for society. People age 65 years and older made up 17 percent of the population in 2020. By 2040, that number is expected to grow to 22 percent. 5 An aging population means higher use of health care services and a greater need for family and professional caregivers.

It also puts the spotlight on taking a lifespan approach to healthy aging. Improving SDOH for people of all ages — with different backgrounds and abilities — can positively affect health and well-being later in life. Public health organizations, health care providers, policymakers, and partners in the public and private sector all play a role in achieving that goal.

Check out the sample scenarios below to learn about ways you can use Healthy People 2030 and other resources in your work to improve SDOH and support older adults’ health and well-being.

Economic Stability

Economic stability means being able to access resources to afford the necessities of life — like affordable housing, healthy foods, and adequate health care. But in the United States, nearly 1 in 10 older adults lives 6 in poverty.

Use the Healthy People 2030 tools and resources below to support your work to increase economic stability for older adults.

Terry, a program manager at a local Area Agency on Aging (AAA) in a midsize rural town, is looking for ways to reduce food insecurity and promote healthy eating among older adults in the community.

• Terry browses Healthy People 2030 objectives and finds Leading Health Indicator (LHI) NWS-01: Reduce household food insecurity and hunger . He reviews disparities data for this objective and sees that households in non-metropolitan areas have a higher rate of household food insecurity than those in metropolitan areas, and that unmarried people (who are more likely to live on their own) are particularly at risk of food insecurity. Terry knows from population surveys that many older adults in his community live alone.
• He looks up Healthy People evidence-based resources (EBRs) related to this LHI and sees the Community Preventive Services Task Force (CPSTF) recommendation about home-delivered and congregate meal services for older adults . He plans to draft a proposal about starting a congregate meal program in his area and involving community partners, like the local senior center. In his proposal, Terry includes the data he found to support his argument that the community needs a congregate meal program.
• To inform his proposal, Terry searches the Healthy People 2030 website for nutrition guidance and finds the Dietary Guidelines for Americans in the list of Healthy People EBRs. On dietaryguidelines.gov , he finds a slide deck with information to help health professionals support healthy eating for older adults. He includes it in his proposal as background information.
• Based on his proposal, Terry is given approval to start a workgroup to draft an implementation plan for a congregate meal program. A survey with older adults in the community shows that people are interested in congregate meal services but worry they’ll feel stigmatized if they go to the senior center or another community site for free food.
• To address this feedback, the workgroup partners with local restaurants to send meal coupons to people age 65 years and older. That way, people can get food from their favorite restaurants or eat out with friends instead of having to go to a congregate meal site.

Social and Community Context

Social and community context, which involves our interactions with family, friends, and others in the community, has a significant impact on our quality of life. And social cohesion — strong relationships and a sense of solidarity within a group — can positively affect health: People who have strong social connections have a lower risk of health conditions like heart disease, stroke, dementia, and depression. They’re also better able to cope with stress and the challenges of daily life. 7 But about 1 in 4 community-dwelling older adults in the United States is socially isolated, 2 which can negatively affect their health and well-being.

Use the resources linked below to promote social cohesion for older adults.

Simone manages a residential care facility for older adults. She notices that certain residents don’t get visitors, and some rarely spend time with other residents. While staff members are doing their best to meet residents’ needs, their busy schedules often don’t allow time to interact with the residents socially. Simone knows that this social isolation is negatively affecting residents’ health.

• Simone searches the Healthy People 2030 website and finds objective HC/HIT‑04: Increase the proportion of adults who talk to friends or family members about their health, which captures whether people feel they have a social support system. She notices that the percentage of adults age 65 years and older with social support has dropped significantly in recent years.
• She also sees that the objective status is getting worse. And when she browses the Social and Community Context webpage, she notices objective AH-03: Increase the proportion of adolescents who have an adult they can talk to about serious problems. This sparks an idea.
• Simone reaches out to her local school district and proposes an intergenerational program. School administrators agree to a pilot program: Once a week, high school students volunteer to visit the residential facility to play board games, do crafts, and talk with residents.
• The program turns out to be a success. Residents report that they look forward to spending time with the students and that the activities keep them mentally engaged. Students report positive experiences from being able to talk about their lives with a caring adult outside of their immediate family or school.

Education Access and Quality

Education access and quality is closely tied to many aspects of health — like the ability to find, understand, and use health information, also known as personal health literacy. Health literacy is a central focus of Healthy People 2030.

But many older adults struggle to understand complex health information, fill out medical forms, or navigate the health insurance system. They may also have trouble accessing and using electronic health care and communication — like telehealth, patient portals, or electronic health records (EHRs). 8

Use the tools and resources below to share health information that older adults can access, understand, and use.

Jenna works as a patient care coordinator at a large geriatric practice. She notices that many older patients call with questions about their health records, like what medicine their doctor prescribed last year or where to find test results. When she points them to their EHR, they say they don’t know how to access that information.

• Jenna searches “health records” on the Healthy People 2030 website and finds this evidence-based resource: The Guide to Getting and Using Your Health Records.
• Using the information in the guide, she puts together a short handout for patients that explains how to access their EHR. She gives the handout to administrative staff and asks them to include it in visit summaries.
• After a few weeks, Jenna checks in with staff to see how patients respond to the new EHR handout. They report that while patients seem interested, many still don’t know how to apply the information.
• Jenna explores the Health Communication topic webpage for strategies to increase patient understanding. She sees Healthy People objective HC/HIT-01: Increase the proportion of adults whose health care provider checked their understanding and starts thinking about ideas for how providers and staff can better support patients in understanding EHR information.
• While exploring the health.gov website, Jenna discovers theODPHP Director’s blog post on enhancing organizational health literacy. Through the blog post, Jenna finds CDC’s health literacy hub and a toolkit for communicating effectively with older adults. She uses the toolkit to draft a memo with actionable tips to help doctors, nurses, and administrative staff talk with patients about the practice’s EHR system. Staff start setting aside a few minutes with each patient to go over the handout and make sure they understand the information.
• To evaluate this strategy’s success, the care coordinator team monitors how often patients age 65 years and older access their EHRs. After 6 months, the team finds that EHR use among this group has gone up 25 percent.

Health Care Access and Quality

Health care access and quality is a priority for people across the lifespan. But as we age, our health care needs change and may become more complex. The risk for chronic health conditions like dementias, heart disease, type 2 diabetes, and arthritis increases with age. Most older adults have at least 1 chronic condition, and many have 2 or more 5 — and these conditions often require special care.

However, many older adults face barriers to getting the care they need. For example, those living in rural areas often have to travel longer distances to see providers, including specialists. And transitioning from employer-sponsored health insurance plans to Medicare can complicate coverage and require people to switch providers. Cost is another significant factor: In 2020, adults age 65 years and older spent an average of nearly $7,000 in out-of-pocket medical costs. 5 These barriers often cause a delay in care, which can worsen health problems and lead to (preventable) emergency visits.

Use the tools and resources below if your work involves improving health care access and quality for older adults.

Alberto is the co-director of a rural public health department. In a district-wide meeting of health organizations, the director of the nearest hospital reports that many older adults come to the emergency department with problems due to untreated illnesses, like pneumonia caused by untreated respiratory viruses.

• Alberto starts exploring the Healthy People 2030 website and finds objective OA-06: Reduce the rate of hospital admissions for pneumonia among older adults. The objective summary notes that flu and pneumococcal vaccines can help reduce hospitalizations for pneumonia.
• On MyHealthfinder, Alberto finds more information about recommended vaccines to protect older adults’ health. He decides to survey older adults in the community to get insights into the barriers they face in getting recommended preventive care like vaccines. To get started, Alberto pulls questions from the National Institutes of Health’s All of Us Research Program health care access and utilization survey.
• The survey shows that many older adults have a hard time getting preventive care — or care for acute illnesses — because the nearest health clinic is at least a 30-minute drive and many older adults in the area don’t have reliable transportation.
• On the Rural Health Information Hub, Alberto finds aRural Transportation Toolkit. He downloads it to get ideas about how to help people in the community get to health appointments. Soon, Alberto and his team partner with the county’s transportation department to set up a shuttle service that residents can use to get to and from medical appointments.
• He also uses CDC’s guidance on planning vaccination clinics to set up a monthly clinic at the local school where residents of all ages can get recommended vaccines, including flu, pneumococcal, and Tdap vaccines.

Neighborhood and Built Environment

Neighborhoods and the built environment greatly affect our chances of aging well. For example, accessible homes and reliable public transit can allow older adults to live independently. And safe, wheelchair-accessible sidewalks, trails, and green spaces make it easier for everyone, including older adults, to get regular physical activity.

Policymakers and community planners can identify goals and strategies to improve neighborhoods and infrastructure to meet older adults’ needs. Use the resources below to get started.

Sam is a project coordinator at a nonprofit organization focused on improving the quality of housing for people in historically underserved neighborhoods. Their organization is in the early planning stage for an initiative to help people “age in place,” which means helping them stay in their homes safely as they age.

• To get started on writing a project plan, Sam checks out the Healthy People 2030 Older Adults webpage. They know that the risk of falling is a big factor that can make homes unsuitable for older adults, so they review objective IVP-08: Reduce fall-related deaths among older adults. They note that the objective’s status is getting worse — and that fall-related deaths are especially high for people age 85 years and older.
• Sam examines data from the United States Census Bureau and finds that their region is below the national average for homes that are aging-ready. They note this data in their project plan and decide to use it to apply for funding.
• To further develop their plan, Sam reviews a U.S. Department of Housing and Urban Development (HUD) publication about aging in place. They use it to map out the topics they need to address in their plan, like home modifications, age-friendly community environments, and cost.
• As they research information about home modifications to support aging in place, Sam remembers an ODPHP blog post they read a while ago. They search their email inbox and find “Wilmington Area Rebuilding Ministry and Healthy People: Repairing Homes to Help Ensure Safety and Independence.”
• Sam reaches out to the Healthy People 2030 Champion organization featured in the blog post. They explain their organization’s planned initiative and receive lots of valuable information to include in their project plan — as well as tips on where to apply for funding.

Learn More

• The Association of State and Territorial Health Officials’ (ASTHO) Social Determinants of Health webpage features relevant blogs, reports, and other materials.
• The National Association of County and City Health Officials (NACCHO) offers tailored resources to help professionals use Healthy People and address SDOH at the local level.
• Healthy People 2030 features several objectives related to the 5 SDOH domains.
• The Healthy People 2030 Social Determinants of Health Literature Summaries provide a snapshot of the latest research about specific SDOH — including a selection of infographics with illustrative examples.